-
Nutrients Jun 2022Malnutrition is a serious problem with a negative impact on the quality of life and the evolution of patients, contributing to an increase in morbidity, length of... (Review)
Review
Malnutrition is a serious problem with a negative impact on the quality of life and the evolution of patients, contributing to an increase in morbidity, length of hospital stay, mortality, and health spending. Early identification is fundamental to implement the necessary therapeutic actions, involving adequate nutritional support to prevent or reverse malnutrition. This review presents two complementary methods of fighting malnutrition: nutritional screening and nutritional assessment. Nutritional risk screening is conducted using simple, quick-to-perform tools, and is the first line of action in detecting at-risk patients. It should be implemented systematically and periodically on admission to hospital or residential care, as well as on an outpatient basis for patients with chronic conditions. Once patients with a nutritional risk are detected, they should undergo a more detailed nutritional assessment to identify and quantify the type and degree of malnutrition. This should include health history and clinical examination, dietary history, anthropometric measurements, evaluation of the degree of aggression determined by the disease, functional assessment, and, whenever possible, some method of measuring body composition.
Topics: Humans; Malnutrition; Nutrition Assessment; Nutritional Status; Nutritional Support; Quality of Life
PubMed: 35745121
DOI: 10.3390/nu14122392 -
Nutrients Feb 2022Malnutrition in hospitalized patients heavily affects several clinical outcomes. The prevalence of malnutrition increases with age, comorbidities, and intensity of care... (Review)
Review
Malnutrition in hospitalized patients heavily affects several clinical outcomes. The prevalence of malnutrition increases with age, comorbidities, and intensity of care in up to 90% of old populations. However, malnutrition frequently remains underdiagnosed and undertreated in the hospital. Thus, an accurate screening to identify patients at risk of malnutrition or malnourishment is determinant to elaborate a personal nutritional intervention. Several definitions of malnutrition were proposed in the last years, affecting the real frequency of nutritional disorders and the timing of intervention. Diagnosis of malnutrition needs a complete nutritional assessment, which is often challenging to perform during a hospital stay. For this purpose, various screening tools were proposed, allowing patients to be stratified according to the risk of malnutrition. The present review aims to summarize the actual evidence in terms of diagnosis, association with clinical outcomes, and management of malnutrition in a hospital setting.
Topics: Hospitalization; Humans; Length of Stay; Malnutrition; Mass Screening; Nutrition Assessment; Nutritional Status; Prevalence
PubMed: 35215559
DOI: 10.3390/nu14040910 -
Nature Reviews. Disease Primers Sep 2017The main forms of childhood malnutrition occur predominantly in children <5 years of age living in low-income and middle-income countries and include stunting, wasting... (Review)
Review
The main forms of childhood malnutrition occur predominantly in children <5 years of age living in low-income and middle-income countries and include stunting, wasting and kwashiorkor, of which severe wasting and kwashiorkor are commonly referred to as severe acute malnutrition. Here, we use the term 'severe malnutrition' to describe these conditions to better reflect the contributions of chronic poverty, poor living conditions with pervasive deficits in sanitation and hygiene, a high prevalence of infectious diseases and environmental insults, food insecurity, poor maternal and fetal nutritional status and suboptimal nutritional intake in infancy and early childhood. Children with severe malnutrition have an increased risk of serious illness and death, primarily from acute infectious diseases. International growth standards are used for the diagnosis of severe malnutrition and provide therapeutic end points. The early detection of severe wasting and kwashiorkor and outpatient therapy for these conditions using ready-to-use therapeutic foods form the cornerstone of modern therapy, and only a small percentage of children require inpatient care. However, the normalization of physiological and metabolic functions in children with malnutrition is challenging, and children remain at high risk of relapse and death. Further research is urgently needed to improve our understanding of the pathophysiology of severe malnutrition, especially the mechanisms causing kwashiorkor, and to develop new interventions for prevention and treatment.
Topics: Child; Humans; Malnutrition; Severity of Illness Index
PubMed: 28933421
DOI: 10.1038/nrdp.2017.67 -
Nutrients Feb 2021Liver cirrhosis is an increasing public health threat worldwide. Malnutrition is a serious complication of cirrhosis and is associated with worse outcomes. With this... (Review)
Review
Liver cirrhosis is an increasing public health threat worldwide. Malnutrition is a serious complication of cirrhosis and is associated with worse outcomes. With this review, we aim to describe the prevalence of malnutrition, pathophysiological mechanisms, diagnostic tools and therapeutic targets to treat malnutrition. Malnutrition is frequently underdiagnosed and occurs-depending on the screening methods used and patient populations studied-in 5-92% of patients. Decreased energy and protein intake, inflammation, malabsorption, altered nutrient metabolism, hypermetabolism, hormonal disturbances and gut microbiome dysbiosis can contribute to malnutrition. The stepwise diagnostic approach includes a rapid prescreen, the use of a specific screening tool, such as the Royal Free Hospital Nutritional Prioritizing Tool and a nutritional assessment by dieticians. General dietary measures-especially the timing of meals-oral nutritional supplements, micronutrient supplementation and the role of amino acids are discussed. In summary malnutrition in cirrhosis is common and needs more attention by health care professionals involved in the care of patients with cirrhosis. Screening and assessment for malnutrition should be carried out regularly in cirrhotic patients, ideally by a multidisciplinary team. Further research is needed to better clarify pathogenic mechanisms such as the role of the gut-liver-axis and to develop targeted therapeutic strategies.
Topics: Amino Acids; Dietary Supplements; Dysbiosis; Gastrointestinal Microbiome; Humans; Liver Cirrhosis; Malnutrition; Micronutrients; Nutrition Assessment; Nutritional Status; Prevalence
PubMed: 33562292
DOI: 10.3390/nu13020540 -
Nutrition in Clinical Practice :... Feb 2017The publication of the landmark paper "Defining Pediatric Malnutrition: A Paradigm Shift Toward Etiology-Related Definitions" launched a new era in diagnosing pediatric... (Review)
Review
The publication of the landmark paper "Defining Pediatric Malnutrition: A Paradigm Shift Toward Etiology-Related Definitions" launched a new era in diagnosing pediatric malnutrition. This work introduced the paradigm shift of etiology-related definitions-nonillness and illness related-and the use of anthropometric z scores to help identify and describe children with malnutrition (undernutrition) in the developed world. Putting the new definition into practice resulted in some interesting observations: (1) Etiology-related definitions result in etiology-related interventions. (2) Illness-related malnutrition cannot always be immediately "fixed." (3) Using z scores in clinical practice often puts the burden of proof on the clinician to show that a child is not malnourished, rather than the other way around. (4) Children with growth failure severe enough to be admitted with "failure to thrive" should always be assessed for malnutrition, and when they meet the criteria, malnutrition should be documented and coded. The publication of the consensus statement came next, announcing the evidence-informed, consensus-derived pediatric malnutrition indicators. Since the indicators are a work in progress, clinicians are encouraged to use them and give feedback through an iterative process. This review attempts to respond to the consensus statement's call to action by thoughtfully appraising the indicators and making recommendations for future review. Coming together as a healthcare community to identify pediatric malnutrition will ensure that this vulnerable population is not overlooked. Outcomes research will validate the indicators and result in new discoveries of effective ways to prevent and treat pediatric malnutrition.
Topics: Adolescent; Adolescent Development; Body Composition; Child; Child Development; Child Nutrition Disorders; Child, Preschool; Consensus; Deficiency Diseases; Evidence-Based Medicine; Failure to Thrive; Growth Charts; Humans; Infant; Infant Nutrition Disorders; Malnutrition; Nutrition Assessment; Pediatrics; Practice Guidelines as Topic; Severity of Illness Index
PubMed: 27765878
DOI: 10.1177/0884533616671861 -
JNMA; Journal of the Nepal Medical... Jan 2022Enterocutaneous fistula is any communication between bowel and skin or atmosphere outside the body. It can be classified by various means by etiology, organ of origin,... (Review)
Review
Enterocutaneous fistula is any communication between bowel and skin or atmosphere outside the body. It can be classified by various means by etiology, organ of origin, etc. Enterocutaneous fistula can occur after any gastrointestinal surgery where there is some trauma during surgery or other associated causes such as malignancy, inflammatory bowel disease, foreign body, etc. Enterocutaneous fistula needs a multidisciplinary approach as its management is a very tedious and complex process. Sepsis, malnutrition, and dyselectrolytemia are three key factors during the management of enterocutaneous fistula, so these should be properly addressed for better and efficient outcomes. There is excess fistula effluent which should be replaced adequately in high output fistula. The nutrition of the patient plays a vital role in the success of enterocutaneous fistula management so if the patient can tolerate oral or enteral feeding should be commenced as soon as possible otherwise parenteral nutrition should be advised. Wound care should be done aggressively, proper skincare, timely drainage of any localised abscesses should be done. Patients should be properly resuscitated and stabilised before any definitive investigations and management. Surgical therapy can be staged and should not be rushed which results in failure of this complex disease process.
Topics: Drainage; Enteral Nutrition; Humans; Intestinal Fistula; Malnutrition; Sepsis
PubMed: 35199684
DOI: 10.31729/jnma.5780 -
Nutrients Dec 2017Malnutrition in children and adults with advanced liver disease represents a tremendous challenge as the nutritional problems are multifactorial. This Editorial comments...
Malnutrition in children and adults with advanced liver disease represents a tremendous challenge as the nutritional problems are multifactorial. This Editorial comments the articles appearing in this special issue of , "Nutrition and Liver disease" dealing with multiple diagnostic and therapeutic features that relate the outcomes of liver disease to nutrition. To improve quality of life and prevent nutrition-related medical complications, patients diagnosed with advanced liver disease should have their nutritional status promptly assessed and be supported by appropriate dietary interventions. Furthermore specific food supplements and/or restriction diets are often necessary for those with hepatic conditions associated with an underlying metabolic or nutritional or intestinal disease.
Topics: Body Composition; Humans; Liver Diseases; Malnutrition; Nutrition Assessment; Nutritional Status; Nutritional Support; Prognosis; Risk Factors
PubMed: 29295475
DOI: 10.3390/nu10010009 -
Nutrients Aug 2021While consent exists, that nutritional status has prognostic impact in the critically ill, the optimal feeding strategy has been a matter of debate. (Review)
Review
BACKGROUND
While consent exists, that nutritional status has prognostic impact in the critically ill, the optimal feeding strategy has been a matter of debate.
METHODS
Narrative review of the recent evidence and international guideline recommendations focusing on basic principles of nutrition in the ICU and the treatment of specific patient groups. Covered topics are: the importance and diagnosis of malnutrition in the ICU, the optimal timing and route of nutrition, energy and protein requirements, the supplementation of specific nutrients, as well as monitoring and complications of a Medical Nutrition Therapy (MNT). Furthermore, this review summarizes the available evidence to optimize the MNT of patients grouped by primarily affected organ system.
RESULTS
Due to the considerable heterogeneity of the critically ill, MNT should be carefully adapted to the individual patient with special focus on phase of critical illness, metabolic tolerance, leading symptoms, and comorbidities.
CONCLUSION
MNT in the ICU is complex and requiring an interdisciplinary approach and frequent reevaluation. The impact of personalized and disease-specific MNT on patient-centered clinical outcomes remains to be elucidated.
Topics: Critical Care; Energy Intake; Enteral Nutrition; Food, Formulated; Humans; Intensive Care Units; Malnutrition; Nutritional Status; Nutritional Support; Nutritive Value; Parenteral Nutrition; Treatment Outcome
PubMed: 34445010
DOI: 10.3390/nu13082851 -
Journal of Visceral Surgery Aug 2015Malnutrition can be detected in up to 50% of patients with gastrointestinal cancer. Although malnutrition reflects the severity of cancer, it is important to underline... (Review)
Review
Malnutrition can be detected in up to 50% of patients with gastrointestinal cancer. Although malnutrition reflects the severity of cancer, it is important to underline that anticancer treatments including surgery likely increase the severity of malnutrition. Additionally, malnutrition is associated with an increased risk of perioperative morbidity and mortality. Nutritional assessment should be a part of pre-treatment work up of gastrointestinal cancer patients because nutritional support has been shown to limit the negative impact of malnutrition on perioperative outcome. The objective of these practice guidelines is to address the following questions regarding nutritional screening in gastrointestinal cancer patients: who should benefit from nutritional assessment, when nutritional assessment should be proposed, how nutritional assessment should be carried out and why nutritional assessment is indicated.
Topics: Gastrointestinal Neoplasms; Humans; Malnutrition; Morbidity; Nutrition Assessment; Nutritional Status; Postoperative Complications; Risk Factors
PubMed: 26315577
DOI: 10.1016/S1878-7886(15)30003-5 -
Tumori Feb 2023In recent years, the influence of nutrition on the health and growth of children has become increasingly important. The relevance of nutrition is even greater for... (Review)
Review
In recent years, the influence of nutrition on the health and growth of children has become increasingly important. The relevance of nutrition is even greater for children who are facing cancer. Malnutrition, within the context of undernutrition and overnutrition, may impact not only the effectiveness of treatments and outcomes, but also the quality of life for patients and their families. In this article, we review nutritional assessment methods for children with cancer, focusing on the specific characteristics of this population and analyze the efficacy of nutritional interventions, which include enteral, parenteral, and nutritional education. From our analysis, two important conclusions emerged: i) there is a need to focus our attention on the nutritional status and the body composition of oncologic children, since these factors have a relevant impact on clinical outcomes during treatment as well as after their conclusion; ii) the support of skilled clinical nutrition personnel would be extremely helpful for the global management of these patients.
Topics: Humans; Child; Nutritional Status; Enteral Nutrition; Quality of Life; Malnutrition; Neoplasms
PubMed: 35722985
DOI: 10.1177/03008916221084740